Studying gender in the experiences of patients with heart failure: A scoping review of qualitative studies and methodological recommendations

BACKGROUND

Considering how gendered experiences play a role in the lives of patients with heart failure (HF) is critical in order to understand their experiences, optimise clinical care and reduce health inequalities.

OBJECTIVES

The aim of our study was to review how gender is being studied in qualitative research in HF, specifically to (1) analyse how gender is conceptualised and applied in qualitative HF research; and (2) identify methodological opportunities to better understand the gendered experiences of patients with HF.

ELIGIBILITY CRITERIA

We conducted a systematic search of literature, including qualitive or mixed-methods articles focussing on patients' perspectives in HF and using gender as a primary analytical factor, excluding articles published before 2000.

SOURCES OF EVIDENCE

Our search returned 3121 records, which were independently screened by two authors, resolving disagreements through a consensus procedure.

CHARTING METHODS

Two reviewers extracted the characteristics of the included studies and methodological quality. We applied the Integrating Sex and Gender Checklist and gender theory as an analytical tool to synthesise results relating to the conceptualisation and application of gender in the included studies.

RESULTS

We included 11 qualitative articles that used interviews (n = 10) or focus groups (n = 1) to investigate the role of gender in experiences of patients with HF. None of the included studies defined their conceptual approach to gender, or used gender-related theoretical frameworks. This led to results and conclusions which were drawn along binary lines - representing gender as two separate, oppositional and mutually exclusive categories, and paying little attention to the dynamic, relational and context-dependent aspects of gender.

CONCLUSIONS

Although researchers have investigated the role of gender in the experiences of patient with HF, methodological improvements are needed to prevent the current retelling of gender as a binary variable with two opposed and mutually exclusive categories. To better understand gendered experiences in HF, researchers need to avoid a reductionist and essentialist approach to gender. To this end, researchers should clearly state their conceptual approach to gender and analyse their findings using state-of-the-art gender theoretical frameworks and intersectional approaches. Ultimately, this will allow the development of tailored and effective clinical care.

Regional MRI volumetry using NeuroQuant versus visual rating scales in patients with cognitive impairment and dementia

BACKGROUND AND PURPOSE

The aims were to compare the novel regional brain volumetric measures derived by the automatic software NeuroQuant (NQ) with clinically used visual rating scales of medial temporal lobe atrophy (MTA), global cortical atrophy-frontal (GCA-f), and posterior atrophy (PA) brain regions, assessing their diagnostic validity, and to explore if combining automatic and visual methods would increase diagnostic prediction accuracy.

METHODS

Brain magnetic resonance imaging (MRI) examinations from 86 patients with subjective and mild cognitive impairment (i.e., non-dementia, n = 41) and dementia (n = 45) from the Memory Clinic at Oslo University Hospital were assessed using NQ volumetry and with visual rating scales. Correlations, receiver operating characteristic analyses calculating area under the curves (AUCs) for diagnostic accuracy, and logistic regression analyses were performed.

RESULTS

The correlations between NQ volumetrics and visual ratings of corresponding regions were generally high between NQ hippocampi/temporal volumes and MTA (r = -0.72/-0.65) and between NQ frontal volume and GCA-f (r = -0.62) but lower between NQ parietal/occipital volumes and PA (r = -0.49/-0.37). AUCs of each region, separating non-dementia from dementia, were generally comparable between the two methods, except that NQ hippocampi volume did substantially better than visual MTA (AUC = 0.80 vs. 0.69). Combining both MRI methods increased only the explained variance of the diagnostic prediction substantially regarding the posterior brain region.

CONCLUSIONS

The findings of this study encourage the use of regional automatic volumetry in locations lacking neuroradiologists with experience in the rating of atrophy typical of neurodegenerative diseases, and in primary care settings.